This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Friday, November 08, 2013

As This Blog Said Years Ago HealthSMART Was A Real Fiasco. Pretty Sad.

Summary: Victoria's statewide healthcare IT system has failed to achieve its goals, and has been criticised for putting patients at potential risk by administering wrong medications or incorrect doses.

The Victorian Department of Health has an inadequate understanding of its clinical IT systems and failed to plan adequately for 19 of its services, according to a report from the state's auditor-general.

The report (PDF) found that the department "significantly underestimated project scope, costs, and timelines, as well as the required clinical and other workflow redesign and change management efforts".

At the centre of the state's issues is the statewide HealthSmart system. The clinical IT system has only been installed at four of the 19 state hospitals that it had been planned for, and only one installation is considered to be fully implemented.

At three of the sites, the systems introduced significant risks to patients, with prescriptions sometimes being manually amended to reflect the actual medication that should be prescribed, or instances where discharge statements would need to be completed even prior to surgery or treatment taking place.

Problems have resulted in over 100 incidents where medication has been missed or nearly missed, or medicines administered at higher doses than prescribed.

"While these three health services have put some manual workarounds in place to reduce the potential risks, they are not fail-safe, they increase inefficiency in the short term, and they do not provide a long-term solution to the identified problem."

The Victorian Department of Health has failed to implement clinical ICT systems across 19 of the state’s health services due to poor planning and inadequate understanding of system requirements, according to a damning audit report released Wednesday.

The audit examined the status of ICT systems in eight Victorian health service providers – including four HealthSMART system rollouts – to determine if they had been appropriately planned and implemented, and benefits were being realised.

Victorian Auditor-General John Doyle said in the report that the department “significantly underestimated project scope costs and time lines”. He said it also underestimated the required clinical and other workflow redesign and change management efforts.

As of this month, the cost of Victoria’s HealthSMART clinical ICT system rollout has blown out to $145.3 million or 150 per cent more than the original budget of $58.3 million, the Auditor-General’s report said.

“This translates to an average installation cost of $36.3 million for each of the four HealthSMART sites,” the report said.

“Clinical ICT systems in four non-HealthSMART sites have cost much less; the average cost of installation is $1.8 million per site, although in terms of functionality, each of the systems has major differences compared to the HealthSMART clinical ICT system,” the report said.

Wednesday, June 27, 2007

Is HealthSMART as Smart as it Claims?

It is funny how things come back to haunt you. In the 2003/4 Victorian Budget an allocation of aadditional funding of $138.5 million was provided budget for a Health Information and Communication Technology (ICT) Strategy to roll out an integrated approach to the implementation and ongoing support of business applications and their underpinning technical architecture.

The full cost of the Health ICT Strategy was estimated at $323.5 million. This included $138.5 million over four years provided in the 2003–04 budget, with the remaining funds to be contributed by hospitals and existing information and communication technology funding from the Department of Human Services.

The additional funding is as follows:

Health ICT Strategy (Additional Funding)

2003/4 18.5M

2004/5 38.0M

2005/6 40.5M

2006/7 41.5M

Total = 138.5M

This means that had things gone as planned the investment would have been finished a day or so from now and all would be wonderful – Health IT wise – in the great Southern State.

Under the Health ICT Strategy, the Government was to remove obsolete, aged products and invest in modern proven systems, based on accepted interoperability standards covering hospital administration systems, clinical systems and electronic medication ordering.

Of course that was never going to happen. We now find that – to quote from the HealthSMART website:

“HealthSMART is a $323M technology program operating across the public health care sector funded through the 2003-04 Victorian State Budget. Initially a four-year program, it is now running over six years from 2003 - 2009.”

To be frank even this timeline looks more than optimistic. Why do I say this?

First, it seems that with clinical systems HealthSMART has adopted the approach of developing State-Wide Builds of the Cerner Software. Experience elsewhere has shown that this can be very problematic (just look at the UK NHS) – as the users don’t see they are getting the system they need that really suits them – rather they are getting a compromise – to them – state-wide solution.

One only has to see that the State-Wide System is being driven by a committee representing 13 different health systems (from major to minor hospitals and from cancer to paediatric hospitals) with over 40 members to recognise that getting agreement on what is to be done will be both slow and tricky to achieve.

Second if one reviews the time-lines provided in each of the progress reports (Roadmaps as they are called) it is clear that with each update issued the time-lines are extending.

Third my making the choice to implement Cerner clinical applications on top of an iSoft Patient Management System they have greatly complicated the operations of each and have lost many of the key benefits of integration that the Cerner system offers.

This is especially true given their approach is to integrate patient administration, outpatients, emergency, laboratory, pharmacy and radiology (at least) onto a Cerner core repository. I believe this is a plain stupid strategy. The amount of context switching from source systems (lab, pharmacy etc) that many clinicians will be forced into is likely to be both time-wasting and annoying.

Fourth with the some of the system selections made there must be the suspicion that adequate financial due-diligence was not undertaken given the difficulties being experienced at present by iSoft.

Fifth, any Health IT strategy that takes six-seven years to implement in the Public Sector has a high risk profile no matter what else goes well initially.

It seems to me that sadly this strategy is facing some existential threats. I hope it can prosper and deliver but it is looking less likely to me as of late June, 2007.

Health revolution stalls over mass funding blowout

Jason Dowling
June 24, 2007

AN UPGRADE of the health system's computer network — which the Government says will "revolutionise" the way hospitals and surgeries deal with patients — has blown way over budget and is years behind schedule.

The upgrade program has cost $363 million so far — $40 million over budget — and is two years behind schedule. It also has been scrutinised by auditors amid allegations of conflicts of interest involving a contractor employed by the Department of Human Services.

My observation over the last decade is that, while it is not required (and there are many honourable exceptions), having a narcissistic personality disorder is certainly looked on positively when recruiting into NSW Health's higher echelons.